15.5 Orthodontic Records, Removable Appliances, Clear Aligners & Orthodontic Laboratory Cases

15.5 Orthodontic Records, Removable Appliances, Clear Aligners & Orthodontic Laboratory Cases

Quick Answer: Before orthodontic treatment, the team collects diagnostic records:

• health and dental histories and a clinical examination
• extraoral and intraoral photographs
• study models or digital scans with a bite registration
• a panoramic radiograph and usually a lateral cephalometric radiograph.

These records support the case presentation and informed consent (5.12.7). Fixed appliances are bonded or cemented and are not removed by the patient. Removable appliances depend on the patient wearing them (5.12.4). Clear aligners (5.12.8) are a series of thermoplastic trays, each moving the teeth a small amount. They are worn about 20 to 22 hours a day and changed on the schedule the orthodontist sets. They often use bonded attachments and sometimes interproximal reduction (IPR). The assistant prepares the laboratory prescription, disinfects and packages items, transfers digital files securely and checks returned appliances (5.12.9, 5.12.10).

1. Indications and Contraindications for Orthodontic Treatment (5.12.5)

Indications:

• crowding or spacing that affects esthetics or makes cleaning difficult
• crossbites, especially those causing a functional shift of the mandible
• a large overjet that puts the incisors at risk of trauma
• a deep bite that injures the palate or gingiva
• impacted or ectopic teeth (for example, canines) that need to be guided into place
• Class II or Class III skeletal patterns that can be improved during growth
• positioning teeth before restorative, prosthetic or implant treatment.

Contraindications or reasons to delay treatment:

• poor oral hygiene and uncontrolled caries
• active, untreated periodontal disease or inadequate bone support
• poor motivation or an inability to cooperate with appointments and home care
• certain medical conditions or medications that need medical consultation first (for example, uncontrolled diabetes, or some bone-modifying drugs)
• unrealistic expectations.

2. Records for Case Presentation and Informed Consent (5.12.7)

Case presentation and consent: the orthodontist explains the diagnosis, the treatment options (including no treatment), the expected duration and cost, and the risks. Common risks are:

• demineralization (white spot lesions) and caries if hygiene is poor
• gingival inflammation
• root resorption
• relapse without retention
• discomfort and TMJ symptoms
• the need for patient cooperation.

The patient (or parent or guardian) signs the consent form, which is filed in the record (section 2.3).

3. Fixed versus Removable Appliances (5.12.4)

Parts of a removable appliance: an acrylic baseplate; retentive clasps (for example, Adams clasps on first molars, ball clasps); an active component such as a finger spring or an expansion screw; and often a labial bow. An expansion screw is turned with a key as the orthodontist directs (for example, one quarter turn at set intervals).

4. Clear Aligner Treatment (5.12.8)

1. Records and scan: photographs, radiographs and a full-arch digital scan (or impressions) with a bite record.
2. Digital treatment plan: the manufacturer's software creates a virtual set-up showing tooth movements stage by stage, and the planned attachments and IPR. The orthodontist or dentist reviews, modifies and approves the plan.
3. Manufacture: models for each stage are 3D-printed and the aligners are thermoformed and trimmed.
4. Delivery appointment:
   • Polish or clean the teeth.
   • Attachments: tooth-coloured composite shapes that give the aligner something to push against. The enamel is etched, rinsed and dried, and the bonding agent applied. A template tray filled with composite is seated and light-cured. The template is removed and excess composite (flash) is cleaned off.
   • IPR (enamel reduction): the dentist removes a small, measured amount of enamel between selected teeth with strips or discs to create space. The amount is checked with a gauge.
   • Try in the first aligners and check the fit.
5. Instructions to the patient:
   • Wear the aligners about 20 to 22 hours a day. Remove them only to eat, to drink anything other than plain water, and to clean.
   • Insert by pressing with the fingertips (seating aids called "chewies" may be used). Remove by releasing from the back teeth first.
   • Brush and floss before reinserting the aligners, so food and sugar are not trapped against the teeth.
   • Clean aligners with a soft brush and cool water; hot water can warp them. Store them in their case, never wrapped in a napkin.
   • Change to the next aligner on the schedule the orthodontist sets (commonly every 1 to 2 weeks). Keep the previous set.
6. Follow-up visits: check that the aligners are "tracking" (fitting fully), replace lost attachments, and order refinement aligners if needed.
7. Retention after treatment (section 15.3).

Common problems:

• Lost or broken aligner: call the office. The patient is usually told to wear the previous or next aligner as directed.
• Aligner not seating: check attachments and patient wear.
• Soreness for the first days of each new aligner is normal.

5. Communicating with the Laboratory or Appliance Manufacturer (5.12.9, 5.12.10)

Prescription: the orthodontist signs a written or electronic prescription. It includes:

• patient and practice identifiers
• the type and design of the appliance
• clasps, springs, screws, wires and acrylic colour
• the teeth involved
• special instructions
• the date the appliance is needed.

Outgoing cases:

• Disinfect impressions, models, bite registrations and appliances (section 11.1).
• Package each item so it cannot be damaged, label it with the patient's name, and enclose the prescription.
• Upload digital scans through the lab's or manufacturer's secure portal.
• Record the date sent and the expected return date in a case-tracking log.

Incoming cases:

• Check the appliance against the prescription and the patient's name.
• Disinfect it before it goes into the patient's mouth.
• Confirm it is ready before the appointment and file the lab slip in the record.
• Contact the lab promptly about errors or damage.

6. Complications and Home Care (5.12.11, 5.12.12)

• White spot lesions and caries: reinforce brushing around brackets, fluoride toothpaste and rinses, and fewer sugary snacks and drinks.
• Gingival enlargement: improve plaque control; use interdental brushes and floss threaders.
• Ulcers and poking wires: use orthodontic wax, and see section 15.3 for managing emergencies.
• Allergy: nickel allergy may require nickel-free wires and brackets; latex allergy requires non-latex elastics and gloves.
• Removable appliance care:
  • Brush the appliance daily with a soft brush and cool water (mild soap or a retainer cleaner may be used).
  • Avoid hot water and keep it away from pets.
  • Always store it in its case.